[Perioperative prevention of complications in surgery of ventral hernias]. / Perioperatsionnaya profilaktika oslozhnenii v khirurgii ventral'nykh gryzh.

OBJECTIVE: To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique. MATERIAL AND METHODS: The study included 144 patients with abdominal wall hernia, who were divided into two representative groups. RESULTS: Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed. CONCLUSION: These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.

[Risk factors of abdominal wound dehiscence in abdominal surgery]. / Faktory riska razvitiya eventratsii v abdominal'noi khirurgii.

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.

[Influence of Chlorhexidine and Prontosan on Dual Species and Monospecies Biofilms Formed by Staphylococcus aureus and Pseudomonas aeruginosa].

The effect of two antiseptics, i. e. chlorhexidine bigluconate 0.5% solution and Prontosan on dual species and monospecies biofilms formed in vitro by the reference strains P. aeruginosa ATCC 27853 and S. aureus ATCC 29213 was examined. It was demonstrated by atomic force microscopy that under the biocide action there occurred phenotype changes of the structural organization of the bacterial biofilms and morphology of the sessile cells: the cocci were lesser in diameter and the rods were reduced. A reliable change of linear cell sizes was accompanied by increase of their roughness (Sq) that was more pronounced for Prontosan. When assessing the cell viability it was found that Prontosan inhibited the bacterial viability in mixed and monospecies biofilms formed on both hydrophilic and hydrophobic abiotic surfaces. In the latter case the biofilm biomass (determined by crystal violet assay) lowered in all the variants of the experiment.

[Surgical and therapeutic treatment of acute pancreatitis].

It was analyzed the features of different forms of acute pancreatitis in 1001 patients including 324 cases with pancreatonecrosis and 245 patients with middle severity of disease. It was shown that monitoring of patients' condition and destructive process in pancreas by using of modified SOFA-scale and evaluation of sonographic signs of inflammation are advisable. Flow indicators including resistance index and the maximum flow velocity in celiac trunk and superior mesenteric artery represented severity of gland's destruction. Sonographic investigation revealed small-focal pancreonecrosis. It allows to differentiate medical tactics. Surgical treatment was performed in 582 patients. Efficiency of surgical treatment is determined by diagnostic methods, timely sanation of destructive focuses of pancreas, abdominal cavity, retroperitoneal fiber, adequate drainage and mini-invasive techniques using in case of purulent complications. The main prognostic factors of development of complications and adverse outcomes are determined.